Condition Management: Tackling Health Care Costs for Employers

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Condition Management: Tackling Health Care Costs for Employers

The Centers for Disease Control and Prevention report that chronic diseases and related lifestyle risk factors account for 86 percent of our nation’s total health care costs.


The Centers for Disease Control and Prevention report that chronic diseases and related lifestyle risk factors account for 86 percent of our nation’s total health care costs and are the leading drivers of health care costs for employers.1 What’s more, it is estimated that by 2020, 83 million people will have three or more chronic diseases.2

In addition to increased medical costs and insurance premiums, employers are also impacted by indirect costs such as increased absenteeism and reduced productivity. Productivity losses from missed work due to chronic conditions cost employers $225.8 billion, or $1,685 per employee, each year.3Productivity lossesOne of the chronic conditions with a high price tag is diabetes. The average medical costs for a person diagnosed with diabetes is about $16,750 per year. That’s about 2.3 times higher than medical costs in the absence of diabetes. Given the growing incidence of this disease, total indirect costs hover at $90 billion, including $3.3 billion in increased absenteeism.4

Heart disease is another costly condition. An employee with cardiovascular disease costs his or her employer nearly 60 hours and over $1,100 more in lost productivity per year than an employee without cardiovascular disease.5

What can we do as employers and insurers to help improve employee health and reduce the economic burden?

Improving health. Reducing costs.

Under the umbrella of care management is condition management, a range of activities intended to improve patient care and reduce the need for medical services by helping patients and caregivers more effectively manage chronic conditions.

Condition management services are often performed as a collaborative effort between healthcare providers and the health insurance company’s case management team.

With the right evidence-based approach, a condition management program can be a helpful mechanism to improve health outcomes and lower costs for employers and employees alike.

Condition Management at ConnectiCare

ConnectiCare’s condition management expertise is grounded in our local roots. It’s what sets us apart from other health plans – that extra we give because we live and work in the communities we serve. We have strong, longstanding relationships with the doctors and hospitals in our network. Our goal is to work hand in hand with them and empower the doctor-patient relationship to improve outcomes.

Our data-driven, personalized Condition Management programs address the diseases where we can have the greatest impact, including:

  • Endocrine: diabetes, metabolic syndrome
  • Cardiac: high blood pressure, heart failure, post-myocardial infarction care
  • Pulmonary: asthma, COPD

Leveraging data and analytics

The first step in developing our Condition Management programs is identifying which members would benefit most from participating and stratifying their risk. This involves more than just identifying the highest-cost members. We integrate data from multiple sources including claims, medication information, diagnostic testing and social determinants to identify members who are at risk or whose risk is rising but are not yet too sick to benefit from the program.

Taking action

Once potential participants have been identified, a comprehensive assessment of each member’s health needs and available social support is done. We often start with phone calls to introduce ourselves and get to know their situation. We ask questions about medications,  nutrition, living situations, family life, physical activity, transportation,  financial resources and social support – all factors that can contribute to managing their health and happiness.

With information in hand, our care managers then serve as the quarterback for each member – developing a care plan and putting together the right multidisciplinary team, working in collaboration with their doctor.  Depending on the member’s needs, we’ll connect them with the right professionals on our staff, including registered nurses, social workers, certified diabetes educators, behavioral health professionals, pharmacists and navigators.

Once the care plan is in place, our care managers then focus on developing a relationship with each member and monitoring their health status. This involves communicating with them regularly and connecting them with community resources as needed. Our team of professionals has built a custom curriculum that uses the teach-back method of adult learning. Through apps and printed and online materials, we educate members on topics including self-help methods, how to talk to their doctor, and how to handle day-to-day challenges.

Condition management at ConnectiCare does not have a definitive start and stop. Data, engagement strategies and outreach methods are continually analyzed and optimized to help our members achieve the best health outcomes possible, and to lower costs for the businesses we serve.

We can help your business too.

Rising health care costs related to chronic conditions continue to be a challenge for employers.  And, when you factor in productivity losses due to employee illness, the importance of choosing a health insurance company with condition management expertise becomes even more evident. Learn more about how ConnectiCare meets the unique needs of employers.


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